Individual
KIMBERLY EVETTE SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
Mailing address
7 IPSWICH CT, FLORISSANT, MO 63033-4816
(314) 741-2778
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2009027569
MO
Other
Enumeration date
09/19/2009
Last updated
09/19/2009
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